Pulmonary mycosis

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Pulmonary mycosis
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Introduction
Antibiotics Chemotherapy Immunosuppressant
Intervention Organ transplantation HIV/AIDS Corti
costeroids
Fungal infections
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Pathogens of pulmonary mycosis
Candida Aspergillus Cryptococcus
neoformans Pneumocystis
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Risk factors
Granulocytopenia ,lt0.5109/L Immunosuppressant ?
Organ transplantation History of fungal
infection AIDS Corticosteroids for 3
weeks Chronic underlying diseases ICU,Mechanical
ventilation Antibiotics Indwelling
catheter,Total parenteral alimentation
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Clinical manifestations of pulmonary candidiasis

• Cough productive of purulent sputum, dyspnea, and
  fever
• The entirely nonspecific manifestations of
  pulmonary involvement help to explain why it is
  often not diagnosed until autopsy
• A typical case would be a patient with
  faradvanced cancer developing a terminal mixed
  pneumonia with bacteria and Candida

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Chest roentgenograms of pulmonary
candidiasis
patchy or lobar infiltrates
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Treatment of pulmonary candidiasis

• Fluconazol,200-400mg/d
• (double at 1st time)
• Vorionazole 6mg/kg,q12h,d1
• 4mg /kg,q12h
• Caspofungin 70mg/d,d1 50mg/d
• Amphotericin B, 0.6-0.7mg/(kgd)

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Pulmonary aspergillosis

• Invasive pulmonary aspergillosis
• Nonproductive cough, high fever, and pleuritic
  chest pain are common pleural friction rubs also
  occur

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Pulmonary aspergillosis

• Aspergilloma
• Many fungus balls are asymptomatic and are
  discovered only during routine roentgenographic
  surveillance. Some patients present with
  hemoptysis, which is the most important clinical
  feature of this illness

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Pulmonary aspergillosis

• Allergic bronchopulmonary aspergillosis (ABPA)
• fleeting pulmonary infiltrates, eosinophilia,
  wheezing, fever, and expectoration of brownish
  plugs is characteristic of ABPA. Some
  exacerbations of ABPA mimic bacterial pneumonia.
  Other exacerbations of ABPA have prominent
  wheezing and may appear at first to be
  exacerbations of ordinary asthma

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Pathology
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CT
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Treatment

• Vorionazole
• Amphotericin B, 1-1.5mg/(kgd)
• Itraconazole d1?2,200mg,iv,bid
• d3-14,200mg,iv,qd
• Caspofungin
• ABPA-prednisone 0.5mg/(kgd)

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Pulmonary cryptococcosis

• Fever, malaise, chest pain, and cough occur
  frequently in symptomatic patients
• Many patients have no pulmonary symptoms but
  have infiltrates on routine chest roentgenograms
  obtained during evaluation for symptoms of
  chronic meningitis.

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Pathology of pulmonary cryptococcosis
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Treatment of pulmonary cryptococcosis

• Fluconazol
• Itraconazole
• Amphotericin B

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Pneumocystis carinii pneumonia

• Classically, PCP presents with fever, a
  nonproductive cough, and dyspnea on exertion.
• High fevers, rigors, purulent sputum, and
  pleuritic chest pain are uncommon and can be used
  to distinguish PCP from pyogenic pneumonia.
• Physical examination of the chest may be normal

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Pathology of PCP
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Treatment of PCP

• SMZ-TMP SMZ 75 mg/(kgd) TMP15mg/(kgd) iv
  drop, bid, 68h/each time, 21d
• Dapsone 100mg,po,qd TMP 15 mg/kg, po,tid, 21d
• Pentamidine 4mg/(kgd) iv drop, 21d

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